Susan Appleby

Course Number Leeds 2S

Submitted June 12th 2010

Number of words: 2725

Essay module 1

Evaluate the claim that Person Centred Therapy offers the therapist

all that he/she will need to treat clients.

In the field of Counselling and Psychotherapy there are many differing theories which

are used to help those who seek counselling including Person Centred Therapy.

Person Centred Therapy has been described as one nation, many tribes by Pete

Sanders. In many parts of the world Person-Centred Therapy (PCT) is seen as a family

of therapies, including Experiential Psychotherapy and Focusing. Closely associated

with PCT are Existential Therapy and various integrative approaches. Since Carl

Rogers’ death, there has been much debate regarding what can and cannot rightly claim

to be called ‘Person-Centred Therapy. ’Proponents of the differing Tribes argue for their

schools of thought. (Warner 2006). At the heart of all the differing thoughts and modes

of delivery, are the six conditions for therapeutic change which Rogers described as

being needed before a client could move towards the change that they wanted to make

in their lives.

Carl Ransom Rogers was an influential American

psychologist, who, along with Abraham Maslow,

was the founder of the humanist approach to

clinical psychology. Maslow was known as the

‘Third Force in Psychology’ but is mainly known

for his thoughts on Self actualization. Prior to

Maslow it was thought that human behaviour was

just a set of behaviours to satiate the drive for

deficits. For example lack of nutrients-feel

hungry-seek food- and eat model. Maslow proposed a wide range of human needs in a

dynamic and changing system, where needs at higher levels would only be addressed

when needs at lower levels had been satisfied. See Fig 1.

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Rogers' person-centred theory emphasized the concept of "self-actualization." which

implies that there is an internal, biological force to develop one's capacities and talents

to the fullest. The human organism’s central motivation is to learn and to grow. Growth

occurs when individuals confront problems, strive to master them and through

experience endeavour to develop new aspects of their skills, capacities, and views about

life, and move forward toward the goal of self actualisation. By way of example, Rogers

(1980) often illustrated the concept with reference to organisms in the natural world. He

wrote about a potato in the root cellar of his boyhood home:

The actualizing tendency can, of course, be thwarted or warped, but it cannot be destroyed

without destroying the organism. I remember that in my boyhood, the bin in which we stored our

winter’s supply of potatoes was in the basement, several feet below a small window. The

conditions were unfavourable, but the potatoes would begin to sprout pale white sprouts, so

unlike the healthy green shoots they sent up when planted in the soil in the spring. But these sad,

spindly sprouts would grow 2 or 3 feet in length as they reached toward the distant light of the

window. The sprouts were in their bizarre, futile growth, a sort of desperate expression of the

directional tendency I have been describing. They would never become plants, never mature,

never fulfil their real potential. But under the most adverse circumstances, they were striving to

become. Life would not give up, even if it could not flourish . . . . So we see that Rogers was

saying that this effective and strong constructive tendency is the underlying basis of the

person-centred approach.

Rogers' groundbreaking understanding was that for a person to be truly helped, the

important healing factor is the relationship itself. His view of human behaviour is that it is

"exquisitely rational" Rogers. (1961 a). Furthermore, in his opinion: "the core of man's

nature is essentially positive" Rogers (1961 b) and he is a "trustworthy organism" Rogers

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(1977). Rogers focused on ways in which the helper could promote certain core

conditions between him or herself and the client. Central to his theory was the

actualizing tendency which was a natural process, yet in order for each human organism

to do so it required the nurturing of a caregiver. Rogers understood that inherently

people need people, and that we are fundamentally dependent on others for our being.

Many critics of the theory have misunderstood Roger’s concepts and commented that

this is outmoded today, and according to Bohart (2007) the critics were saying that it

“glorifies the individual at the expense of others”.

Wilkins (2003) argued that Roger’s concept of self-actualization is culturally biased,

reflecting a Western cultural emphasis on the separate, autonomous individualistic self.

However, Bohart states that Roger’s concept of self as culture-specific is compatible with

cultures which view the self in relational rather than individualistic terms, and even

cultures that have no concept of self. Self-actualizations means enhancing or actualizing

the self as the self is defined for that person and culture.

Roger’s did believe that the tendency of actualization of a person in therapy was to

always go in a positive pro social direction, but critics state that it may lead to self

centred narcissistic behaviour (Bozarth and Brodley, 1991). Roger’s recognized that

environmental and social factors (introjected conditions of worth) could inhibit or distort

the process of actualization so that a negative rather than positive outcome may occur,

but also that the fully functioning person is ‘soundly and realistically social’ (Rogers 1961

c)

Rogers postulated that therapeutic movement will only occur if, and only if, 6 conditions

were in place between the therapist and client.

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The first condition of Person centred therapy is that therapist and client should be in

psychological contact. Roger’s wrote little about the first condition because he believed

that it was clear and simple. ‘The first condition specifies that a minimum relationship… must

exist. I am hypothesizing that significant positive personality change does not occur except in a

relationship (Rogers 1957). The relationship is not seen as a third object in the room with

the counsellor and the client but is the client and the counsellor. They bring themselves

into the room, and in doing so a unique and ever changing relationship is the result

(Sanders 2006 a). Research into contact between animals and people who live in social

groups has shown that in order to grow and become confident then it must be in a

psychologically interactive way. Those who were deprived of such conditions like the

children in the orphanages of Romania and the monkeys in Harlow’s experiments grew

up with permanent behavioural and emotional problems. (Harlow 1959, Carlson 1999,

Bowlby, 1953, Warner 2002). Rogers thought that psychological contact was an all or

nothing one off event, but others like Rose Cameron (2003) and Whelton and Greenberg

(2002) see psychological contact as a variable and dynamic quality in relationships, and

Margaret Warner(2002:79) says that the ‘contact can be viewed as a continuum. Despite

the differing views of the various “Tribes”, the one overriding view is that psychological

contact is essential if the therapeutic process is going to work. It can be simply the mere

recognition of the other person in the room or a deeply shared experience between the

therapist and client.

Client incongruence, a state of being vulnerable and anxious is presented as the second

of the six conditions which Rogers defined as a ‘discrepancy between the actual experience

of the organism and the self picture of the individuals experience insofar as it represents that

experience’ ( Rogers 1957b), and which he saw as being necessary for therapy to be

successful. Pearson (1974) thought that this condition has created some confusion since

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the relationship between incongruence and felt anxiety or vulnerability is complex. All

people are incongruent to some degree all of the time (since human beings can never

fully symbolize their experience), and some sorts of incongruence may actually lower

anxiety. Rogers concept of incongruence was simply saying that clients sense that they

have underlying issues that have distorted their sense of equilibrium and therefore are

motivated to seek counselling.. This second condition affects how clients will respond to

counselling because the change that needs to happen has to come from within the client

and cannot happen against their will. For example if someone is referred by a doctor, or

school, or made to attend counselling with a spouse or parent then the client will not be

in a state of incongruence and the first condition will not take place, without which there

is no therapeutic relationship.

The third core condition is that the second person, the therapist, is congruent in the

relationship. By congruent Rogers understood it to be real, genuine and transparent. As

early as 1946 he wrote about the fact that the therapist should have a ‘genuine interest

in the client’. Rogers makes it very clear in a video on the internet where he is talking

about what it means to be congruent when he says “Can I be real in the relationship; this

has come to have an increasing amount of importance to me over the years. I feel that genuiness

is another way of describing the quality I would like to have. I like the term congruence by which I

mean that what I am experiencing inside is present in my awareness and comes out though my

communication. In a sense when I have this quality I am all in one piece in the relationship.

There is another word that describes it for me; I feel that in the relationship I would like to have a

transparency. I would be quite willing for my client to see all the way through me and that there

would be nothing hidden. And when I’m real in this fashion that I’m trying to describe I know that

my own feelings will often bubble up into awareness and will be expressed, but be expressed in

ways that but won’t impose themselves on my client. (You Tube 2010). Despite Rogers

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insistence that being congruent with clients is of paramount importance a number of

studies over the years have shown that there no significant relationship exists between

levels of congruence and outcomes in the therapeutic relationship (Klein et al 2002,

Orlinsky et al 2004, Burckell and Goldried 2006, Feifel and Eells, 1963) In contrast

Cooper (2008 a ) has suggested that this may be because it is a ‘high frequency’ event

in therapy and therefore the correlation between genuiness and outcome are not truly

recognised. Without an empathetic response from the therapist I believe that the client

would not feel valued or understood and the therapeutic relationship would break down.

In the development of self concept Rogers also stated that the fourth condition

"unconditional positive regard, that is the complete acceptance and support for a person

no matter what they say or do, is necessary for self-actualization. By showing

unconditional positive regard or prizing, clients are said to feel valued and are so accept

and take responsibility for themselves. ( Rogers 1957:98) Conversely, self-actualisation

is thwarted by conditional positive regard, when acceptance is dependent on the positive

or negative evaluation of a person's actions. Those raised in an environment of

conditional positive regard, Rogers felt, only feel worthy if they match conditions laid

down by others - "conditions of worth," - which, in turn, can lead to shaping themselves

determined not by their organismic valuing or actualizing tendency, but by a society that

may or may not truly have their best interests at heart. Numerous studies have looked

at how unconditional positive regard relates to therapeutic outcome and these are

summed up by the Division 29 Task Force ( Steering Committee 2002) concluding that it

was ‘a promising and probably effective’ element of the therapeutic relationship. (Cooper

2008)

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The fifth core concept states that the counsellor should experience an empathic

understanding of the client’s internal frame of reference. Each of us perceives and

responds to our environments as a unified and organised whole, and each from our

unique frame of reference. Our understanding of the world is shaped through our

experiences and each time these are interpreted on the basis of our personal value

system. In order for a therapist to understand a client's behaviour then it should be from

the internal frame of reference of the client. Empathy is not just listening but trying to feel

the experiences and feelings that the other person has at that moment in time. It

involves stepping into their shoes and laying aside ones own perceptions, values,

perspectives and meanings as far as possible (Sanders 2006 b). If the therapist attempts

to understand the client on the basis of his own personal experiences, that would be an

external frame of reference. When the therapist remains within the client's frame of

reference which is his own understanding of the world, it enhances empathy and

promotes unconditional positive regard. Holding an external frame of reference might

convey to the client that the therapist has their own agenda or criticising the client. The

question is would the therapeutic process take place if the counsellor did not enter the

client’s world so personally? From the large number of studies that have been carried

out in an attempt to measure client’s reaction to the therapist empathy the evidence

shows it to be a ‘demonstrably effective element of the therapeutic relationship’.

(Steering Committee, 2002)

The final condition “Client perception” is as important as all the others, and is

complimentary to the idea that the first condition “psychological contact” is continued.

Rogers (1959:213) wrote ‘That the client perceives, at least to a minimal degree, condition 4

and 5, the unconditional positive regard of the therapist for him and the empathetic understanding

of the therapist’. To some degree client perception has been ignored over the years.

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Tudor in 2000 referred to it as the lost condition. Sanders( 2004 c) states that ‘Carl

Rogers made it clear that the client was the centre of the therapeutic process and

furthermore it was the client who had the final say as to whether the ‘therapist-provided

conditions’ were actually provided (as opposed to being assumed by the therapist)’

Dagmar Pescitelli(1996) argues that the theory of person-centred therapy may not be

effective for severe psychopathologies such as schizophrenia (deemed to have strong

biological component) or other disorders such as phobias, obsessive-compulsive

disorder or even severe depression (currently effectively treated with drugs and cognitive

therapy). Pescitelli (1996) cites one meta-analysis of psychotherapy effectiveness that

looked at 400 studies, and person-centred therapy was found least effective. In fact, it

was no more effective than the placebo condition (Glass 1983; cited in Krebs &

Blackman, 1988). In contrast, Meta-analyses of Person Centred Therapy as a whole

supports the theory that it is an efficacious and effective form of therapy, no matter what

‘Tribe’. It is similar to other orientations such as CBT and psychodynamic therapy, with

evidence indicating that all schools may be efficacious for clients with depressive,

traumatic, schizophrenic and health related problems, but there is less evidence on the

impact of anxiety disorders (Elliott, Greenberg et al., 2004)

Person Centred Therapy has at it’s centre the client’s best interests, and insists on

allowing the client to work out their perceived deficits in a warm and accepting

atmosphere.

Does Person Centred Therapy offer the therapist all that he/she will need to treat

clients? There is virtually no research on the question as to whether the non-directive

stance relates to therapeutic outcomes because it is an attitude or an ethic and has yet

to be subjected to direct empirical evaluation. (Cooper 2008 b). A large number of

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studies have been carried out looking at directive ways of working and have found that

some like Cognitive Behavioural therapy to be to effective, but only when the therapist

practiced in ways that would be typically associated with psychodynamic therapy, such

as interpreting unconscious wishes and emphasising the client’s feelings. (Jones &

Pulos, 1993). I would contend that whatever mode of counselling is used to help a

person find their way to better mental health that the 6 core conditions need to be in

place. The client needs to feel that they have been understood, and that the therapist

has experienced an empathic understanding of their internal frame of reference and has

tried to communicate this experience to the client.

Rogers posited that the client becomes more “integrated, more effective . . . . He

changes his perception of himself, becoming more realistic in his views of self. He

becomes more like the person he wishes to be. He values himself more highly. He is

more self-confident and self-directing” (Rogers, 1961 d). This is what is meant by

Becoming a Person.

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